The prognostic value of the preoperative c-reactive protein/albumin ratio in ovarian cancer

Abstract

Background: Inflammation plays an important role in the pathogenesis of ovarian cancer. This study sought to investigate the association between the preoperative c-reactive protein/albumin ratio (CRP/Alb) and oncological outcomes in ovarian cancer patients. Methods: Two hundred patients with histologically verified ovarian cancer between June 2006 and July 2012 were retrospectively reviewed. Overall survival was evaluated by the Kaplan-Meier method and log-rank test. The significance of risk factors for overall survival was evaluated with the Cox proportional hazards model. Additionally, area under the receiver operating characteristic curve (AUC) was used to compare the predictive ability of CRP/Alb, Glasgow Prognostic Score (GPS), modified GPS (mGPS), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), prognostic index (PI) and prognostic nutritional index (PNI). Results: The optimal cutoff value of CRP/Alb was 0.68. Increased CRP/Alb (≥0.68) was associated with advanced stage, residual tumor, ascites, elevated serum carbohydrate antigen(CA)-125 level, GPS, and mGPS (all p < 0.05). Patients with high CRP/Alb had poor overall survival compared to those with low CRP/Alb (p < 0.001). Multivariable analysis showed that CRP/Alb (Hazard Ratio (HR) 1.330, 95% confidence interval (CI) 1.131-1.564, p = 0.001), tumor stage (HR 1.577, 95% CI 1.189-2.091, p = 0.002), residual tumor (HR 2.337, 95% CI 1.518-3.597, p < 0.001) and age (HR 1.017, 95% CI 1.000-1.035, p = 0.046) were independent prognostic factors for overall survival. Additionally, the CRP/Alb showed greater AUC values at 1 year (0.692), 3 years (0.659), and 5 years (0.682) than GPS, mGPS and PNI. Conclusions: The CRP/Alb is a novel independent marker of poor prognosis among ovarian cancer patients and shows superior prognostic ability compared to the established inflammation-based prognostic indices.

Clinical significance and prognostic value of C-reactive protein/albumin ratio in gastric cancer

“…Among them, systemic inflammatory response and nutritional status are two important contributors [21] . Evidences showed that CAR was an important inflammation-based prognostic indicator that associated with various cancer survival outcomes [22,23] . In the present study, we found that CAR was an independent prognostic indicator in patients with gastric cancer, which was in agreement with previous studies [12,13,20] .…”

Prognostic Significance of the Preoperative Prognostic Nutritional Index in Epithelial Ovarian Cancer Patients: A Systematic Review and Meta-analysis of Cohort Studies

“…A total of 11 articles were selected for full review, as shown in Figure 1. Six articles were excluded for various reasons, leading to the final inclusion of five articles for study [10][11][12][13]16]. Table 1 summarizes the characteristics of the five included studies.…”

“…However, evidence of the significance of the PNI in OC is controversial. A retrospective study by Feng et al [10] on 875 OC patients revealed null results between preoperative PNI and overall survival (OS) of OC, in contrast to other studies that showed a significant association [11][12][13]. Interestingly, a systematic review and meta-analysis in 2019 by Wang et al [14] showed significant association of the PNI with the prognosis of patients with gynecological cancer.…”

“…First, the reference group for comparison was set as OC patients with a low PNI as proposed by Feng et al [10]. Conversely, other included studies [11][12][13] set the reference comparison group as OC patients with a high PNI. These mixed risk estimates were summarized directly instead of recalculating on the basis of comparable reference groups.…”

Simple acute phase protein score to predict long‐term survival in patients with acute myeloid leukemia

“…The CRP/albumin ratio has been investigated in various solid tumors, including hepatocellular carcinoma, non‐small cell lung cancer, ovarian, and pancreatic adenocarcinomas . In these studies, high levels of acute phase proteins as expressed by an elevated ratio (high CRP and/or low albumin) were consistently associated with adverse outcome.…”